Drug interactions
Benzhydrocodone / acetaminophen + Tramadol
Severity: Major
Benzhydrocodone / acetaminophen and Tramadol: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Benzhydrocodone is a prodrug of hydrocodone, so combining it with tramadol duplicates opioid therapy. This increases the risk of profound sedation, respiratory depression and death, and tramadol adds seizure and serotonergic risk. Acetaminophen doses may also be duplicated if tramadol is given as a combination product.
What this interaction means in plain words
Benzhydrocodone / acetaminophen and Tramadol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive opioid-receptor CNS and respiratory depression, with tramadol's serotonergic effects.
What to do
Avoid duplicate opioid therapy; if unavoidable, use the lowest doses for the shortest time and monitor respiration and sedation. Check total daily acetaminophen intake.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Tramadol
- Isocarboxazid + Tramadol Contraindicated
- Olanzapine / samidorphan + Tramadol Contraindicated
- Phenelzine + Tramadol Contraindicated
- Procarbazine + Tramadol Contraindicated
- Rasagiline + Tramadol Contraindicated
- Safinamide + Tramadol Contraindicated
Frequently asked questions
Can I take Benzhydrocodone / acetaminophen with Tramadol?
MediHelp rates the interaction as major. Benzhydrocodone / acetaminophen and Tramadol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Benzhydrocodone is a prodrug of hydrocodone, so combining it with tramadol duplicates opioid therapy. This increases the risk of profound sedation, respiratory depression and death, and tramadol adds seizure and serotonergic risk. Acetaminophen doses may also be duplicated if tramadol is given as a combination product.
How serious is the interaction between Benzhydrocodone / acetaminophen and Tramadol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid duplicate opioid therapy; if unavoidable, use the lowest doses for the shortest time and monitor respiration and sedation. Check total daily acetaminophen intake.
What other medicines interact with Tramadol?
MediHelp also lists interactions of Tramadol with, for example, Isocarboxazid, Olanzapine / samidorphan, Phenelzine. The full list is on the Tramadol page.
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